intestinal adhesion



Overview

What is intestinal adhesion?

Definition

Intestinal adhesion refers to abnormal adhesion between intestine and intestine, between intestine and peritoneum, and between intestine and internal organs (e.g. pancreas, ovary) caused by various reasons.

Classification

Classification according to etiology

Congenital intestinal adhesions (primary intestinal adhesions): less common, can be due to developmental abnormalities or meconium peritonitis.

Acquired intestinal adhesions (secondary intestinal adhesions): common, mostly caused by postoperative abdominal surgery or abdominal inflammation.

Classification according to the extent of the adherent bowel

Extensive adhesions: including sheet-like adhesions.

Solitary adhesions: the most common site of adhesions is the small intestine.

Pathogenesis

Intestinal adhesions are one of the common postoperative complications of abdominal surgery, and studies have shown that about 90% of abdominal surgery patients have varying degrees of intestinal adhesions.

Questions you may be concerned about

What medications can I take for intestinal adhesions?

Bowel adhesions are physical adhesions and no treatment is needed for asymptomatic bowel adhesions.

If symptoms occur, you can follow the doctor’s instructions to take bifidobacteria, lactobacilli and other drugs to regulate intestinal flora, for paroxysmal abdominal pain is intense, can be given antispasmodic drugs such as scopolamine. If there is a combination of infection, oral gentamicin sulfate granules can be taken. But the drug can not completely lift the intestinal adhesion, the serious condition should be timely surgical treatment.

Can intestinal adhesion be cured by itself?

Intestinal adhesion cannot be cured by itself.

Intestinal adhesion refers to the abnormal adhesion of intestinal tube with itself or surrounding tissues and organs, which is often caused by trauma, infection, bleeding, foreign body stimulation in the abdominal cavity.

If the intestinal adhesions do not have symptoms at present, they can be observed temporarily without treatment, but they will not heal on their own. If the symptoms are mild or relatively severe intestinal adhesions, you can choose conservative treatment or surgical treatment.

Do adhesions get worse over time?

Generally speaking, intestinal adhesions do not get worse over time and can usually be improved with effective and timely treatment. However, some untimely and incomplete treatments may lead to worsening of the condition.

Therefore, attention should be paid to the early stage of intestinal adhesions to avoid delaying the condition, which may lead to the development of intestinal adhesions into intestinal obstruction.

Causes

Causes

Injury

Surgery

Prolonged exposure of the intestinal tube during surgery, large surgical wounds, bleeding or damage to the plasma membrane, incomplete debridement of the abdominal cavity, or intra-abdominal foreign bodies may cause intestinal adhesions.

Abdominal trauma

The abdomen is suddenly impacted by the outside world, and although the impacted area is not ruptured and perforated, there is some damage or bloody exudate flows into the abdominal cavity, causing edema and adhesion of the surrounding tissues.

Chemotherapy

Adhesions are caused by the outflow of drugs into the abdominal cavity from abdominal heat therapy, chemotherapy and family planning adhesive plugging surgery.

Inflammation

Inflammation in the abdominal cavity

Inflammatory edema, exudate or pus overflow into the abdominal cavity causing adhesions.

Tuberculous peritonitis

Tuberculous peritonitis can be divided into dry and wet types, the dry type is characterized by tuberculous nodules on the peritoneum, in addition to fibrinous exudate, mechanization triggered by abdominal organs, the greater omentum, the mesentery extensive adhesions.

Intestinal tuberculosis

In patients with intestinal tuberculosis, fibrin exudate and most grayish-white tuberculous nodules can be seen on the plasma membrane surface of the intestines, while the intestinal wall is often thickened by fibrous tissue proliferation and adhesions are formed with adjacent intestinal tubes or the greater omentum.

Others

Tumor infiltrative growth destroys the surrounding tissues to form adhesions or individual unexplained intestinal adhesions.

Incomplete degeneration of the vitelline duct, forming a band of adhesions between the umbilicus and the ileum; or due to meconium peritonitis, which forms extensive adhesions in the abdominal cavity; or a band of peritoneal sidewalls in the abdominal cavity caused by intestinal malrotation.

Predisposing factors

Starch and talcum powder on sterile gloves, threads, cotton fibers, resected tissues and other foreign bodies in the abdominal cavity during abdominal surgery induce the production of granulation tissue and the occurrence of intestinal adhesions.

Pathogenesis

The mechanism of intra-abdominal adhesions has not been clarified, but it is generally recognized that adhesions are a normal response of the peritoneum to repair itself.

When the peritoneum is stimulated by trauma, inflammation or foreign bodies, an acute inflammatory reaction occurs, and a large amount of fluid containing fibrinogen is exuded, and the exudate can coagulate into fibrous loose adhesions within a few hours, sticking the plasma membrane surfaces of the neighboring organs together, and if fibrous adhesions are not absorbed in time, firm fibrous adhesions are easily formed.

Symptoms

Most of the patients with intestinal adhesions are asymptomatic, and the symptoms that may appear are generally characterized by irregular pain in the abdomen, sometimes accompanied by a pulling sensation.

Mild intestinal adhesions may have no obvious symptoms, or only mild abdominal pain and bloating after eating.

Moderate intestinal adhesions are characterized by significant abdominal pain, accompanied by abdominal distension, eructation, vomiting, and dyspnea, difficulty in defecation, and other symptoms.

Severe intestinal adhesions with heavier or more frequent abdominal pain and distention, dry feces, and bowel movements with the help of bowel medication.

Main Symptoms

Abdominal pain occurs when there is strong peristalsis above the adhesion site. Mild abdominal pain and bloating may occur after eating. Sometimes the pain is relieved significantly after a bowel movement. Lack of appetite and nausea may also occur.

Other symptoms

Depending on the degree of intestinal adhesions, incomplete and complete intestinal obstruction may occur.

Symptoms of incomplete intestinal obstruction

Abdominal pain: to a lesser extent, it may be characterized by abdominal fullness, distension or paroxysmal colic, which may flare up after being relieved by triggers.

Nausea and vomiting: initially there may be no vomiting, with the prolongation of the obstruction, the degree of severity is getting more and more serious, nausea and vomiting may occur.

Persistent abdominal distension: the slow passage of food through the intestinal canal here may cause abdominal distension when the function of exhaustion is obstructed.

Systemic symptoms: generally mild, long obstruction time can appear water electrolyte disorders, malnutrition, etc..

Symptoms of complete intestinal obstruction

Abdominal pain: often the first symptom, mostly paroxysmal colic. Abdominal pain occurs when there is strong peristalsis above the adhesion site. When the intestinal muscle is overworked and becomes temporarily flaccid, the abdominal pain disappears.

Vomiting: Impairment of intestinal function (e.g., intestinal obstruction) may be characterized by reflex vomiting in the early stages and reflux vomiting in the later stages.

Abdominal distension: when the exhaust function is obstructed, it can cause abdominal distension, frequent vomiting without obvious abdominal distension, and in severe cases, the exhaust stops and the abdominal distension is obvious.

Constipation and cessation of defecation: when complete intestinal obstruction occurs, the patient’s defecation and defecation disappear.

Complications

Intestinal perforation, intestinal necrosis

The intestinal wall is congested and edematous, the permeability increases, and the intestinal tube may ulcerate and perforate due to ischemic necrosis in severe cases. The manifestation is sudden severe pain in the right lower abdomen, accompanied by nausea, vomiting, thin pulse and temporary drop of body temperature.

Abdominal abscess

When intestinal obstruction is prolonged or strangulation occurs, the intestinal wall and peritoneum are often infected with a variety of bacteria. It manifests as fever, increased pulse rate, and gradual weakness.

Female Infertility

In women, abdominal adhesions within the pelvis or uterus can compress or obstruct parts of the reproductive system and lead to infertility.

Consultation

Department of Medicine

General Surgery

If you have symptoms such as chronic abdominal pain, unrelieved bloating, vomiting, or stopping anal defecation, it is recommended that you seek medical attention.

Emergency Department

If there are symptoms such as severe abdominal pain, nausea and vomiting, shock (e.g., high fever, rapid heart rate, apathy, cold extremities, etc.), it is recommended to consult a doctor immediately.

Preparation for medical treatment

Preparation for medical treatment: registration, preparation of documents, common problems

Tips for medical treatment

Try to keep a record of symptoms and their duration for the doctor’s reference.

Preparation List

Symptom list

Pay particular attention to the time of onset of symptoms, special manifestations, etc.

Where is the discomfort? How long has it lasted?

Any abdominal pain?

Was there nausea or vomiting? What does the vomit look like?

Any bowel movements, gas?

Any other symptoms?

Any recent changes in appetite, bowel movements, mental status, or weight?

Have you had any tests or treatments?

List of medical history

Any trauma to the abdomen?

Have you had any abdominal surgery?

What are your usual living habits? Do you eat regularly and do you smoke or drink alcohol?

Checklist

Test results in the past six months, which can be brought to the doctor’s office

Routine blood test, routine stool test, fecal occult blood test

Blood biochemistry

Abdominal Ultrasound, Abdominal X-ray, Abdominal CT

Diagnosis

Diagnosis is based on

Diagnosis is based on a history of abdominal surgery, peritonitis, and other medical conditions, as well as symptoms, signs, and ancillary tests.

Medical history

History of previous abdominal surgery, inflammation, trauma, bleeding, etc.; congenital can be due to developmental anomalies or meconium peritonitis, often occurring in children.

Clinical manifestations

Abdominal distension, abdominal pain, nausea, vomiting. In severe cases, the anus stops venting and defecation.

Physical examination may reveal increased intestinal peristalsis, palpable intestinal pattern, etc.

Laboratory Tests

Routine blood tests

To find out whether infectious lesions are present. The white blood cell count is normal or mildly elevated in simple intestinal obstruction, but is significantly elevated in stricture obstruction, and the neutrophil count is also increased.

Fasting is not necessary before the test.

Biochemistry, blood gas analysis

Check liver function, kidney function and other indicators; changes in serum potassium, sodium and chloride.

May reflect acid-base balance and electrolyte disorders. Exclude other diseases.

Keep calm and do not exercise strenuously before the examination.

Occult blood test

To determine whether there is gastrointestinal bleeding.

Vomit and fecal examination with a large number of red blood cells or positive for occult blood should be considered as a blood transport disorder in the intestinal tubes.

Abstain from eating meat and foods containing animal blood, and abstain from taking iron and vitamin C.

Imaging

X-ray

Find out about the accumulation of gas and fluid in the bowel.

X-ray cannot detect adhesions. Isolated, prominently distended bowel loops that do not change position over time or have pseudotumor-like shadows are seen, as well as gas-fluid flatness in the bowel.

Women who are preparing for pregnancy or are pregnant need to speak to their doctor before the test. Remove metal objects from the abdomen.

CT Abdomen

To find out the condition of the abdomen.

Mild intestinal adhesions do not show up on CT. Severe intestinal adhesions CT may show signs such as multiple fluid planes, dilated intestinal collaterals, and angulation of the intestinal tubes.

Fasting and water fasting before the examination, the specific time as prescribed by the doctor (usually start fasting the night before, fasting breakfast and water on the day of the examination, to ensure fasting). Remove metal objects from the abdomen.

Ultrasound of the abdomen

To find out the presence of gas and fluid in the intestines.

Ultrasound can be a non-invasive method of evaluating abdominopelvic fluid. Examination is limited when intestinal distension is evident.

Fasting is not necessary before the examination.

Laparoscopic exploration

Refresh

It can detect the adhesion of intestinal tubes, peritoneum and viscera in the abdominal cavity.

For patients with severe intestinal adhesions, conservative treatment is ineffective and timely management is needed, laparotomy is feasible for exploration to determine whether the patient has intestinal adhesions and other severe symptoms.

Severe cardiac, pulmonary, hepatic and renal insufficiency; those with huge pelvic and abdominal masses are contraindications to laparoscopic exploration.

Differential diagnosis

Intussusception

Intussusception may manifest as abdominal pain, bloody stool and abdominal mass. It occurs in young children and is less common in adults. Abdominal ultrasound is a common examination method, which can assist the clinical diagnosis through the characteristic images of intussusception.

Intestinal torsion

Small bowel torsion is characterized by sudden severe abdominal pain, accompanied by frequent vomiting, abdominal distension and symptoms of intestinal obstruction such as cessation of bowel movement. It is usually seen in male young adults, and the CT shows the whirlpool sign.

Gastric ulcer

Gastric ulcer is characterized by recurrent rhythmic pain in the epigastrium, heartburn, regurgitation, belching, belching, nausea and vomiting. It can be identified by endoscopy to determine the location, size, shape and number of ulcers.

Digestive Tract Tumor

Early stage of digestive tract tumor may be asymptomatic or only have mild abdominal pain, and there may be loss of appetite, emaciation, fatigue, nausea, vomiting, change of bowel habit or blood in stool. The diagnosis can be confirmed and differentiated by endoscopy.

Treatment

Principles of treatment

Intestinal adhesion is a physical adhesion disease. Mild symptoms can be relieved by conservative treatment, while severe cases require surgical separation and prophylactic application of anti-adhesion materials.

If adhesive intestinal obstruction occurs, it should be determined whether the intestinal tube has blood flow obstruction and whether there are indications for surgery. Complete obstruction requires surgery to relieve the obstruction; incomplete obstruction can be treated with gastrointestinal decompression and other internal conservative treatment, and some patients can be relieved on their own; those who cannot be relieved can be selected for surgical treatment according to different situations.

General treatment

If intestinal adhesion does not cause symptoms or complications, good dietary habits should be practiced.

Diet: Pay attention to light diet, eat small meals, chew slowly and do not overeat. Meanwhile, try to avoid barbecue and frying, greasy and indigestible food.

Lifestyle habits: usually pay attention to rest and regular diet, avoid strenuous exercise after meals. Keep bowel movement smooth to avoid intestinal obstruction. The methods to keep bowel movement smooth include drinking more water, eating more dietary fiber and exercising more.

Conservative treatment

Suitable for patients with mild condition. Generally include the following measures: fasting, continuous gastrointestinal decompression, intravenous rehydration to maintain water-electrolyte balance, parenteral nutrition, anti-infection, anti-shock treatment, etc.

Flora regulating drugs

Regulate intestinal flora to relieve bloating, commonly used bifidobacteria, lactobacilli, etc.

Intestinal antispasmodics

Paroxysmal abdominal pain is intense, give antispasmodic drugs such as scopolamine. Opioid analgesics should not be used before the cause is unknown and surgical treatment is not determined.

Capsaicin

Patients with intestinal obstruction are given Capsaicin to stimulate laxation.

Anti-infection treatment

Antibiotics are used to control infection in patients secondary to intra-abdominal infection.

Parenteral nutrition

During fasting, the body can be supplemented with nutrient solutions such as glucose, amino acids, fat emulsions, electrolytes, vitamins, trace elements, and water through intravenous input.

Others

Anti-shock and appropriate fluid replacement.

Oxygen may be administered if abdominal distension can affect lung function.

Use growth inhibitors to reduce the amount of gastrointestinal fluid produced.

All drugs should be used as prescribed by the doctor, and should not be adjusted in dosage or discontinued on their own.

Surgery

If the disease is recurrent and conservative treatment is ineffective, or if the disease is serious and there is adhesive intestinal obstruction (e.g. strangulated intestinal obstruction and complete intestinal obstruction), surgery should be carried out in a timely manner.

Surgical methods

Simple adhesion release

Suitable for intestinal torsion or intussusception, etc. to eliminate the local cause of obstruction. If strangulated intestinal obstruction occurs due to intestinal adhesions, open surgical treatment is necessary.

Partial intestinal resection

For patients with adhesive intestinal obstruction who fail conservative treatment or have recurrent episodes of adhesions, and for those with too dense adhesions, necrotic or tumor-bearing intestinal segments should be resected, and abscesses should be drained, etc., in order to remove the local lesions.

Intestinal short-circuit anastomosis

When there is difficulty in resecting the obstructed area, in order to relieve the obstruction, the distal and proximal intestinal tubes of the obstructed area can be separated for short-circuit anastomosis or enterostomy.

Postoperative care

Encourage early bed activity to promote the return of intestinal function as soon as possible, and minimize the incidence of intestinal adhesions as a key measure.

Maintain semi-recumbent position.

Encourage early activities out of bed, such as stretching and lifting legs within 12 hours, and sitting beside the bed or getting out of bed within 24 hours.

Gradually resume diet strictly according to medical advice: to follow the order of small amount of water – fluid food – semi-fluid food – soft food – general food to resume eating, each stage of 1 to 2 days before moving to the next stage if there is no discomfort.

After surgery, consume more high protein and high fiber food, plus oral enteral nutrition preparation, avoid spicy, greasy food, keep diet light and healthy.

Corkscrew can be used to help the patient to have moderate bowel movements.

Prognosis

Cure

The disease cannot be cured by itself, and active treatment can improve the symptoms.

Most of the patients with intestinal adhesion can be relieved with conservative treatment and have a good prognosis.

In case of intestinal obstruction, peritonitis, intestinal perforation and shock, it can be life-threatening if not treated in time.

Harmfulness

Patients with intestinal adhesion can suffer from recurrent chronic abdominal pain due to adhesion, which affects daily work and life.

Some patients with severe symptoms such as abdominal pain, abdominal distension and dry feces may even form intestinal obstruction or even intestinal necrosis and other complications, which are life-threatening.

Daily

Daily Management

Daily care

Abdominal warmth: Use a warm water bag, or irradiate the abdomen with the help of infrared physical therapy device, which can relieve the pain caused by intestinal adhesion and reduce intestinal edema.

Abdominal massage: Use the other hand to massage the abdomen first in a clockwise direction for 5 minutes, followed by another 5 minutes in a counterclockwise direction.

Light physical activity to promote intestinal peristalsis and defecation and reduce intestinal adhesions.

Dietary management

Eat a light diet, eat small meals, chew slowly and avoid overeating.

Food should be easy to digest, soft and less residue.

Eat less gas-producing food, spicy stimulating food, greasy food egg yolk, etc..

Eat regularly, for fruits, no special contraindications.

Lifestyle Habits

Regular work and rest, avoid staying up late.

Quit smoking and drinking.

Keep a happy mood, avoid mental stimulation.

Pay attention to keep warm, especially pay attention to abdominal warmth.

Take appropriate physical exercise to enhance physical fitness.

Follow-up and review

Regular follow-up and review will help to detect recurrence in time.

If symptoms such as abdominal pain, nausea and vomiting occur after abdominal surgery, it is recommended to go to the hospital for examination.

If the symptoms do not subside, or even worsen, you need to see a doctor promptly.

Physical examination, abdominal X-ray and other tests may be done during follow-up.

Prevention

Actively prevent and treat abdominal inflammatory diseases, such as Crohn’s disease, diverticular disease, endometriosis, pelvic inflammatory disease, peritonitis, etc., to avoid intestinal adhesion.

The use of laparoscopic minimally invasive surgery, for intestinal adhesions in patients with more serious intraoperative anti-adhesion materials and drug prevention can be used.

Postoperative prevention, mainly to promote the early recovery of intestinal peristalsis, including encouraging patients to get out of bed early, healthy diet, maintain laxative, avoid abdominal cold, avoid or reduce intestinal obstruction.